Maxillary sinusitis of odontogenic origin springerlink. About a case at the university hospital center of bouake. Department of internal medicine, university hospital of heraklion, crete, greece. Descending necrotizing mediastinitis as a complication of. Dnm progresses rapidly, without specific clinical findings, and requires invasive procedures, including mediastinal drainage or open thoracic surgery. Mandibular molars are most often the cause of odontogenic infections. Cervical cellulitis and mediastinitis caused by odontogenic infections. Persistent necrotizing mediastinitis after dental extraction. Pathogens gain access to deeper neck spaces through disruption of the oral mucosa. Jun 21, 2018 odontogenic is a medical term for tissues that gives origin to teeth. Descending necrotizing mediastinitis of odontogenic origin in a young male patient.
Mediastinitis as complication of odontogenic infection. Cervical necrotizing fasciitis of nonodontogenic origin. Odontogenic definition of odontogenic by medical dictionary. However, epithelial rests may be the origin for the cyst lining later. However, only rare reports of candidal deep neck space infections and mediastinitis secondary to oropharyngeal infections exist 5, 6, 14. Major complications occurred in 4 patients, including mediastinitis in 4, septic shock in 2, lung empyema in 1, pleural effusion in 2, and pericardial effusion in 1. We report 3 cases of mediastinitis of odontogenic origin. Use of interventional radiology in the management of. However, an increase in individual case reports of candida mediastinitis has appeared in the literature since 1990 3,58. Formation of an oropharyngeal or odontogenic abscess can spread the infection to the neck tissues and further via the cervical fascia planes to the mediastinum, leading to the development of cervical necrotizing fasciitis cnf and descending necrotizing mediastinitis dnm 17. Non candida albicans candida mediastinitis of odontogenic.
Acute mediastinitis is an infectious process and can cause fever, chills, tachycardia. Descending necrotizing mediastinitis after sequestrectomy in. Descending necrotizing mediastinitis and mediastinal. Cervical necrotizing fasciitis of odontogenic origin. Non candida albicans candida mediastinitis of odontogenic origin in a diabetic patient. For example, mucous cyst of the oral mucosa and nasolabial duct cyst are not of odontogenic origin. Descending necrotizing mediastinitis dnm secondary to descending odontogenic and pharyngeal is rare but potentially lifethreatening complication of an odontogenic and pharyngeal infections. Diffuse descending necrotising mediastinitis and pleural.
Cervical necrotizing fasciitis and acute mediastinitis of. Mediastinitis secondary to oropharyngeal infections is usually polymicrobial due to the indigenous oral microflora. The aim of the study was to present the optimal diagnostic and treatment approach to. Introduction maxillary sinusitis is an infection or inflammation of the maxillary sinus. The deep cervical fascia plays an important role in determining the location and course of spread of infections within the soft tissues of the neck. Mediastinitis definition of mediastinitis by medical dictionary. Objectives most of the oral infections with odontogenic origin are very common and can be treated by tooth extraction, endodontic therapy, or surgical treatment. The aim of the study was to present the optimal diagnostic and treatment approach to this severe, lifethreatening condition. Descending necrotizing mediastinitis pubmed central pmc. Acute suppurative mediastinitis of oropharyngeal origin in.
Microbiology of mediastinitis jama internal medicine. It has been reported that the overall mortality rate is 1947%. The most common form is the postsurgical mediastinitis after. Mediastinitis is an inflammatory process that can be presented acute or chronic. Are you a health professional able to prescribe or dispense drugs. In the era of modern antibiotics, acute suppurative mediastinitis asm without previous surgical intervention or esophageal perforation is a rare infectious complication in childhood. It may be explained by the delay in clinical presentation, which allows the infection to continue spreading along the cervical soft tissue. Mediastinitis occurs with complicated oropharyngeal infections when these infections expand beyond their site of origin and enter into the fascial planes of the neck allowing them to track into the mediastinum. Descending necrotizing mediastinitis can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Potentially lethal consequences can quickly occur once the mediastinum is subjected to the ravages of an anaerobic infection. Cnf are odontogenic in origin, reports of this disease in the dental literature are sparse. Mediastinitis from odontogenic or deep cervical infections is extremely rare in the era of antibiotic drugs. It is predominantly a disease of young men and 6070% of cases are of odontogenic origin. Oropharyngeal infections were also the leading cause in our series.
Extensive complications and potentially lethal consequences can result when the. Deep neck infections from odontogenic origin are usually a multiple space process. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous. Therapeutic strategies in dental origin mediastinitis. Noncandida albicans candida mediastinitis of odontogenic origin in a diabetic patient article pdf available in medical mycology 464. Know the causes, signs, symptoms, treatment and spread of odontogenic infections. The case above describes a monomicrobial infection with mssa which is typically unusual for mediastinitis of odontogenic origin. The diagnosis of necrotising fasciitis requires a high index of suspicion.
Complication, mediastinitis, odontogenic infection, transcervical drainage. Most infections of odontogenic origin do not spread beyond the confines of the root space of the tooth. Necrotizing fasciitis is a potentially lifethreatening and rapidly progressive soft tissue infection that can lead to significant skin and soft tissue loss, mediastinitis, vascular thrombosis or rupture, limb loss, organ failure, and death. Descending necrotizing mediastinitis dnm is a rare but severe life threatening complication of infection in the oropharyngeal region that descends to the mediastinum through the connecting deep and superficial cervical fascial planes. The vast majority of causative bacterial organisms are polymicrobial in origin.
Descending necrotizing mediastinitis after sequestrectomy. Severe odontogenic infections with septic progress a constant and. Odontogenic cysts clinical features radiographic features differential diagnosis yasmin moidin 2008 batch al azhar dental college thodupuzha 2. Descending necrotizing mediastinitis the journal of. Descending necrotizing mediastinitis dnm is a serious complication of odontogenic infections, being associated with a high mortality rate. Descending necrotising mediastinitis is a rare complication of odontogenic infection. Considerations for the spread of odontogenic infections.
Long term sequelae can be minimised with prompt and appropriate. Craniocervical necrotizing fasciitis of odontogenic origin with mediastinal extension. Hernandez 2, 1 department of internal medicine, paul l. Estrera has proposed three criteria for the diagnosis of mediastinitis of odontogenic origin. The anatomic pathways between the cervical fascial planes and the mediastinum which permit the spread of infection from a distant focus into the thoracic cavity are discussed. Pain of odontogenic and nonodontogenic origin pocket dentistry. Despite surviving the odds, his recovery was complicated by severe dysphagia, resulting in gastrostomy feeding for 6 months. Mediastinitis from odontogenic and deep cervical infection. Pdf descending necrotizing mediastinitis as a complication of. Descending necrotizing mediastinitis is a rare complication that can be secondary to dental infections or surgical procedures involving the oral region. Craniocervical necrotizing fasciitis of odontogenic origin. Mediastinitis as a complication of propionibacterium acnes odontogenic infection evgenibrotfain, 1 leonidkoyfman, 1 lisasaidelodes, 2 abrahamborer, 2 yaelrefaely, 3 andmotiklein 1.
A potential source of mediastinitis in our patient could be her skin, especially given the presence of multiple scratches on her chest, bumper car injury leading to blunt chest wall trauma prior to symptom onset, mssa. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development. Using prealbumin as an inflammatory marker for patients with deep space infections of odontogenic origin. Lifethreatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Doctors can often make the diagnosis of mediastinitis based on the symptoms if people have a condition that can cause mediastinitisfor example, if people have symptoms that suggest mediastinitis and have recently had a procedure involving the chest or the esophagus or have tuberculosis or another slowly developing infection. Invasive pulmonary aspergillosis in an elderly patient with a cerebral abscess of odontogenic origin. Descending necrotizing mediastinitis is the most severe form of mediastinal infection. More than 90% of all infections in the head and neck region can be traced back to an odontogenic origin. Descending necrotizing mediastinitis of odontogenic origin in a. Two cases are presented in detail, and the remainder are given in the form of a chart. Mediastinitis is a rare, progressive, and destructive infectious process due to cervical or odontogenic infections, which, if not diagnosed early, may lead to several complications, including airway involvement and even an imminent risk of death. While odontogenic soft tissue infections of the head and neck are common, progression to necrotizing fasciitis is relatively rare. Descending necrotizing mediastinitis of odontogenic origin. Pain can occur with mediastinitis but the location of the pain depends on which part of the mediastinum is involved.
We report a case of acute odontogenic sepsis in a 59yearold man, presenting with diffuse, descending necrotising mediastinitis complicated by pleural empyema. It is associated with a high morbidity and mortality rate. Untreated odontogenic infections can cause lifethreatening complications such as necrotizing fasciitis, descending necrotizing mediastinitis, internal jugular vein thrombosis, cavernous sinus thrombosis, carotid artery pseudoaneurysm or rupture, and systemic inflammatory response. Service of odontostomatology and maxillofacial surgery, university hospital center of bouake, ivory coast.
Although uncommon, direct spread of dental infections into the maxillary sinus is possible due to the close relationship of the maxillary posterior teeth to the maxillary sinus. Descending necrotizing mediastinitis, first named and described by pearse in 1938 1, is the most lifethreatening and still underestimated type of acute mediastinitis and includes cases with descending fast spreading polymicrobial infection from localized odontogenic or oropharyngeal abscesses. Noncandida albicans candida mediastinitis of odontogenic. Use of interventional radiology in the management of mediastinitis of. Noncandida albicanscandida mediastinitis of odontogenic origin in a diabetic patient diamantis p. A case series paolo cariati 1, fernando monsalveiglesias 2, almudena cabelloserrano 1, alfredo v alencialaseca 3. A case series paolo cariati 1, fernando monsalveiglesias 2, almudena cabelloserrano 1, alfredo valencialaseca 3, blas garciamedina 2 1 oral and maxillofacial surgery resident.
Thus, asm always constitutes a grave, lifethreatening condition. In the preantibiotic era these infections accounted for up to 30% of cases of mediastinitis, but currently rarely occur. Descending necrotizing mediastinitis and acute infectious mediastinitis has often a fulminate and fatal course. Acute mediastinitis occurs secondary due to esophagus perforation or induced by infections of odontogenic or retrapharyngealorigins. Odontogenic infections can have severe complications. Odontogenic infections are the most common oropharyngeal infections reported as causes of dnm. Descending necrotising mediastinitis is a rare disease with fewer than 100 cases reported in english language publications. All patients with odontogenic infections requiring. Elias tinyiko mabaso a research report submitted to the faculty of health sciences, university of the witwatersrand, johannesburg, in partial fulfilment of the requirements for the degree. To study the microbiologic and clinical characteristics of patients with mediastinitis. Odontogenic infections are one of the most common dental problems, which affect 80%90% of the population. Odontogenic medical definition merriamwebster medical. All children who presented to the departments of paediatric dentistry of the westmead centre for oral health and the childrens hospital at westmead with a facial swelling of odontogenic.
Deep neck infection and descending mediastinitis as a. Clinical evidence of severe oropharyngeal infection. Tooth andor its supporting structures are often source of pain. View or download all content the institution has subscribed to. The most common causes are histoplasmosis and tuberculosis infections. Noncandida albicanscandida mediastinitis of odontogenic. July august pages mediastinitis and longterm survival after coronary artery bypass graft surgery. What is odontogenic infectioncausessymptomstreatment. Introduction classification types of odontogenic cysts conclusion reference 3.
Treatment of mediastinitis using videoassisted thoracoscopic. Pdf mediastinitis as complication of odontogenic infection. Article in french jarboui s1, jerraya h, moussi a, ben moussa m, marrakchi m, kaffel n, haouet k, ferjaoui m, zaouche a. The sepsis syndrome in odontogenic infection thomas pb. Nongranulomatous fibrosing mediastinitis is caused by an idiopathic reaction to drugs and radiation therapy. A small number of mediastinitis are the result of the spread of an infection arising from the oropharynx and this is the most severe. The dilemma the clinician faces is finding the correct origin of this pain whereby an effective treatment will provide relief. We have recently encountered five such cases, with a rapid spread of the inflammatory process into the mediastinum resulting in a number of local and systemic.
When the infection has its origin in the cervical or oral region it is termed as descending necrotising mediastinitis dnm. Granulomatous mediastinitis is due to a granulomatous process of the mediastinal lymph nodes leading to fibrosis and chronic abscesses in the mediastinum. That odontogenic epithelium is critical in normal tooth development. Mediastinitis appears to be a disease of young men with a mean age in the mid fourth decade of life and a maletofemale ratio of 61. Health, general necrotizing fasciitis care and treatment diagnosis patient outcomes. Odontogenic infection can spread from the submandibular space to the retropharyngeal space, and lead to descending necrotizing mediastinitis dnm. To determine the characteristics, aetiology and management of facial swellings of odontogenic origin in the paediatric population. Improved oral hygiene, prompt recognition and treatment of infection, and the availability of antibiotic therapy have practically eliminated this rapidly spreading type of infection. Complication, mediastinitis, odontogenic infection, transcervical. Pdf cervical necrotizing fasciitis and acute mediastinitis. Acute mediastinitis is a serious infection of the mediastinal connective tissues and the. Odontogenic and non odontogenic tumors of the jaws are a relatively rare and heterogeneous group of benign and malignant neoplasms, hamartomas, and other bonerelated lesions that demonstrate great variability in etiology, biologic behavior, and clinical significance. Please tell us where you read or heard it including the quote, if possible. An incorrect evaluation of this apparent improvement may result in fatal mediastinitis and septic shock.
Dnm should be suspected in cases of refractory and progressively worsening odontogenic and pharyngeal infections. Descending mediastinitis secondary to cervical necrotizing. Once infected, the mediastinum offers very little resistance to the spread of infection, due in part to a lack of efficient anatomic barriers. Severe odontogenic infections with septic progress a. The vast majority of mediastinitis are the result of esophageal perforation or an infection of the mediastinum after a transsternal cardiac procedure. Herein, we report an unusual case of a 37yearold male with a bilateral submandibular hard swelling after the left third molar extraction. Despite a prompt pharmacological therapy and surgical intervention, a delayed diagnosis is still responsible for a too high mortality rate about 40%. The diagnosis, classification, and management depend on computed tomography ct findings. Chapter 21 odontogenic and non odontogenic tumors of the jaws introduction. The infections that commonly affect head and cervical areas are frequently from odontogenic origin and to a lesser frequency, proceeding from foreign bodies or trauma to this region. Only rare reports of candidal deep neck space infections and mediastinitis secondary to oropharyngeal infections exist 9. Cervical necrotizing fasciitis and acute mediastinitis of odontogenic origin. Descending necrotizing mediastinitis as a complication of odontogenic infection.
Odontogenic infection is a complicated dental problem that originates within a tooth or in the adjacent tissues that hold the tooth. Odontogenic etiology accounts for 10% to 12% of cases of maxillary sinusitis. Severe deep neck space infections and mediastinitis of odontogenic origin. A cute mediastinitis is usually secondary to infection elsewhere. Mediastinitis from odontogenic or deep cervical origin is extremely rare. That is, a mixture of normal oral flora and pathogenic flora are nearly always identified as causative organisms in cases of deep neck space infections.
The findings in five survivors of mediastinitis of odontogenic or deep cervical origin are presented. Often they may be complaining of pain from their teeth. Patients can present with pain of odontogenic or non odontogenic origin, arising from the facial area, temporomandibular joints, ear, eyes, pharynx and larynx. Aerobic or facultative bacteria only were present in three patients 18%, anaerobic bacteria only in seven 41%, and mixed aerobicanaerobic flora in seven 41%. May 26, 2007 odontogenic infections can have severe complications. Odontogenic origin of descending necrotizing mediastinitis. A case of candida mediastinitis after dental extraction. Presentation and management of facial swellings of. Sep 11, 20 maxillary sinusitis odontogenic origin 1.
Anaerobes were isolated in 73% of the infections, whereas streptococcus species were uniformly present. Odontogenic maxillary sinusitis usually manifests unilaterally and its pathophysiology, microbiology and manageme. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. When the upper mediastinum is involved, the pain is typically retrosternal pain. Between 1985 and 1992, six men mean age, 49 years with. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high published mortality rate near 40%. Incision, drainage, and debridement represent the principal management. If a periapical dental infection or dentaloral surgery procedure violates the schneiderian membrane integrity, infection will likely spread. Age, gender, the origin of infection, time to diagnosis. This retrospective study evaluated the causative factors, treatment, complications and management outcomes of patients with descending necrotising mediastinitis dnm of odontogenic origin treated at charlotte maxeke and chris hani baragwanath academic hospitals for comparison with other published international studies. Necrotizing mediastinitis 1440 spread into the mediastinum may take 1248 h 7. Descending necrotizing mediastinitis of odontogenic origin in.
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